Treat-to-target strategy in patients with rheumatoid arthritis: Audit of adherence from real world clinical data

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NSAID: nonsteroidal anti-inflammatory drug; CDAI: Clinical Disease Activity Index; CQL: Chloroquine; DAS28: Disease Activity Score 28; csDMARD: Conventional synthetic disease-modifying antirheumatic drug; BioDMARD: biological disease-modifying antirheumatic drug; HCQ: hydroxychloroquine; LEF: leflunomide; MTX: methotrexate; PDN: prednisone; SDAI: Simplified Disease Activity Index; hidroxychloroquine; LEF: leflunomide. * Initial clinical, serological and radiological assessment of the disease. ** Factors of poor prognosis: seropositivity, erosive disease, high level of clinical activity and extra-articular manifestations. *** Assessment of clinical response can be from 4 to 12 weeks in the case of active disease, every 12 weeks in the case of low disease activity and up to every 6 months in the case of sustained remission, without neglecting pharmacovigilance. Clinical remission or a low level of activity is considered adequate response." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mario H. Cardiel, Sandra Carrillo, Marcela Pérez, Lilia Andrade, César Pacheco Tena, Luis H. Silveira, Leonardo Limón, Sergio Cerpa, Sergio Gutiérrez Ureña, Sergio Durán, Fedra Irazoque Palazuelos, Sandra Muñoz López, Sandra Araceli Sicsik Ayala, Leonor Barile, María Azucena Ramos Sánchez, Daniel Grajeda Portes, Margarita Portela, Alina Hernández Bedolla, José Luis García-Figueroa, Mauricio Montero, Carlos Abud-Mendoza, Marco Ulises Martínez Martínez, David Herrera van Ostdam, Virginia Pascual-Ramos, Javier Merayo-Chalico, Istar Guzmán-Sánchez, María Esther Pérez-Bastidas, Jorge Enrique Aguilar Arreola, Alejandra López Rodríguez, Greta Reyes-Cordero, Humberto Alfredo Ricardez, María Fernanda Hernández Cabrera, Guadalupe Olvera-Soto, Daniel Xibillé Friedmann" "autores" => array:34 [ 0 => array:2 [ "nombre" => "Mario H." 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The area under the receiver operating characteristic curve was 0.86 (CI 95% 0.79–0.92) showing a good discriminatory capacity. A value of 2 points showed a sensitivity of 90.38% and a specificity of 63.64% (black arrow), while a value of 4 points showed a sensitivity of 51.9% and a specificity of 90.9% (white arrow)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Paulin, Tracy Jennifer Doyle, Juan Francisco Mercado, Leandro Fassola, Martín Fernández, Fabián Caro, María Laura Alberti, María Elena Crespo Espíndola, Emilio Buschiazzo" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Paulin" ] 1 => array:2 [ "nombre" => "Tracy Jennifer" "apellidos" => "Doyle" ] 2 => array:2 [ "nombre" => "Juan Francisco" "apellidos" => "Mercado" ] 3 => array:2 [ "nombre" => "Leandro" "apellidos" => "Fassola" ] 4 => array:2 [ "nombre" => "Martín" "apellidos" => "Fernández" ] 5 => array:2 [ "nombre" => "Fabián" "apellidos" => "Caro" ] 6 => array:2 [ "nombre" => "María Laura" "apellidos" => "Alberti" ] 7 => array:2 [ "nombre" => "María Elena Crespo" "apellidos" => "Espíndola" ] 8 => array:2 [ "nombre" => "Emilio" "apellidos" => "Buschiazzo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357432100037X?idApp=UINPBA00004M" "url" => "/21735743/0000001700000004/v1_202103261153/S217357432100037X/v1_202103261153/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Brief Report" "titulo" => "Treat-to-target strategy in patients with rheumatoid arthritis: Audit of adherence from real world clinical data" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "212" "paginaFinal" => "214" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José-Luis Andréu, María Auxiliadora Martín, Héctor Corominas, José Javier Pérez-Venegas, José Andrés Román-Ivorra, Fernando Sánchez-Alonso, Ángel Gil de Miguel" "autores" => array:7 [ 0 => array:4 [ "nombre" => "José-Luis" "apellidos" => "Andréu" "email" => array:1 [ 0 => "jlandreus@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Auxiliadora" "apellidos" => "Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Héctor" "apellidos" => "Corominas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "José Javier" "apellidos" => "Pérez-Venegas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "José Andrés" "apellidos" => "Román-Ivorra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Fernando" "apellidos" => "Sánchez-Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Ángel" "apellidos" => "Gil de Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Rheumatology Department, H.U. Puerta de Hierro Majadahonda, Majadahonda, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Research Unit, Sociedad Española de Reumatología, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unitat territorial de Reumatologia, Hospital Universitari de Sant Pau & Hospital Dos de Maig, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Rheumatology Department, H.C.U. Virgen Macarena, Sevilla, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Rheumatology Department, H.U.P. La Fe, Valencia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Cátedra de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estrategia de tratar por objetivos en pacientes con artritis reumatoide: auditoría de la adherencia en práctica clínica habitual" ] ] "textoCompleto" => "IntroductionRheumatoid arthritis (RA) is a systemic autoimmune disease whose main characteristic is a chronic inflammation of diarthrodial joints. In absence of a successful therapy, RA leads to irreversible destruction of articular structure, functional impairment and loss of quality of life.With the advent of biologic therapy and the optimal use of conventional disease-modifying anti-rheumatic drugs (DMARDs), being methotrexate (MTX) the corner-stone of RA treatment, remission of disease or, at least, a state of low disease activity (LDA) are considered nowadays realistic goals in the management of RA, as different guidelines and recommendations suggest.<a class="elsevierStyleCrossRefs" href="#bib0090">1–3</a>Several studies have compared standard of care by personal rheumatologist's judgement deciding the changes in therapy versus thigh control and dynamic escalation of the therapy according to pre-specified therapeutic targets.<a class="elsevierStyleCrossRefs" href="#bib0105">4–7</a> These studies have demonstrated better outcomes with the so called “treat to target” (TTT) strategies. Thus, the current paradigm of optimal clinical care of patients with RA recommends reaching a state of remission or LDA of the disease, assessed by composite indexes of activity, by means of a tight control and a dynamic adjustment of available therapeutic options, using a TTT strategy.<a class="elsevierStyleCrossRefs" href="#bib0125">8,9</a>Although the TTT strategy is widely known and assumed by rheumatologists as beneficial and feasible,<a class="elsevierStyleCrossRefs" href="#bib0135">10–12</a> there are barriers in routine clinical practice that could hinder its wide implementation and the optimal management of RA patients. The objective of our study was to objectively assess the level of implementation of the TTT recommendations in routine clinical care of RA patients.MethodsThis study is an audit of clinical records of patients diagnosed of RA and managed in Spanish rheumatology units.All the rheumatology units of Spain were invited to participate in the study. Those units that accepted to participate sent to the research team a computerized anonymized list of adult patients fulfilling the 2010 ACR-EULAR criteria for RA<a class="elsevierStyleCrossRef" href="#bib0150">13</a> and diagnosed of RA between January 1st, 2010 and December 31st, 2013.In order to accomplish an adequate representation of the RA population, 19 patients were randomly chosen from the list provided by every department.Independent auditors, specifically trained by the research team, assessed the clinical records, verifying the fulfilling of the TTT recommendations in the management of the patients. Clinical, epidemiological and demographic data were recorded from every patient.The study was approved by the ethic committees of every participant hospital. Descriptive statistics was used for the presentation of the results.ResultsForty-six rheumatology units participated in the study. From them, a total of 856 clinical records, randomly chosen, were available for the audit. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the patients. Mean age of them was 54 years and 71% of patients were women. Mean duration of RA was 2 years.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>An explicit assessment of the disease activity as a determinant element considered to select the therapy was recorded in 32% of the CRs. Use of at least a composite disease activity score (DAS28, SDAI or CDAI) was recorded in 61% of the cases. In the follow-up, 38% of patients reached a state of low disease activity, defined by a DAS28 <3.2 and/or a SDAI ≤11.In only 4% of the CRs, appointments every 4 weeks using a composite activity score had been recorded during the early stage while trying to reach remission after the diagnosis of RA.Disease activity monitoring every 6–8 months after reaching the therapeutic target was recorded in 73% of the cases.In 99% of the cases, the clinicians had registered patient's comorbidities and these associated conditions had been considered in planning the therapeutic approach and objective.DiscussionOur data have shown a low implementation of the TTT strategy in the routine clinical practice of the rheumatology units participating in the study. The data are somewhat disappointing since the widespread dissemination of TTT strategy and the acceptance of their feasibility by rheumatologists<a class="elsevierStyleCrossRef" href="#bib0155">14</a> would lead to the expectation of a wider implementation of this treatment strategy.There are several barriers that have been suggested for the implementation of the TTT strategy.<a class="elsevierStyleCrossRef" href="#bib0160">15</a> Likely, the main ones are the lack of time in real world clinical practice to use the compound indices of activity and the difficulty to get appointments for the patients with RA month by month during the escalation of medication to achieve a state of remission or, at least, LDA. A potential solution would be to maintain preferential citation slots in order to monitor patients every 1–3 months. This would require an additional effort in rheumatologist resources but, on the other hand, the TTT strategy has been shown to be more effective than usual care<a class="elsevierStyleCrossRef" href="#bib0165">16</a> and even cost-efficient in the medium and long term.<a class="elsevierStyleCrossRef" href="#bib0170">17</a>Although our results are quite disappointing, we used a very stringent criterion, four weeks, to judge whether the TTT strategy was being followed. Likely, the results would not have been so poor if we had used 3 months instead of 4 weeks as the criterion of excellence to adjust the treatment of patients with RA during the escalation of therapy in order to reach a state of remission or LDA.In conclusion, a minority of the patients with RA are managed according to the TTT strategy, that is, using combined indices of activity to monitor the response to treatment and follow-up every 4 weeks until the therapeutic goal is achieved.Ethical approvalThis article does not contain any studies with human participants or animals performed by any of the authors.Compliance with ethical standardsThis study was funded by an unrestricted grant provided by the biopharmaceutical company AbbVie.Conflict of interestsThe authors declare no conflict of interest. Ángel Gil de Miguel declares that he is Director of the Chair of Evaluation of Health Outcomes Universidad Rey Juan Carlos/Abbvie." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1489859" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1352819" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1489860" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1352818" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical approval" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Compliance with ethical standards" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:2 [ "identificador" => "xack521621" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-15" "fechaAceptado" => "2019-10-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1352819" "palabras" => array:2 [ 0 => "Rheumatoid arthritis" 1 => "Treat-to-target" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1352818" "palabras" => array:2 [ 0 => "Artritis reumatoide" 1 => "Terapia por objetivos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe current paradigm of the management of rheumatoid arthritis (RA) recommends achieving a state of remission or low disease activity through the treat-to-target strategy. Our study assesses adherence to this strategy. MethodPatients with RA (ACR-EULAR 2010 criteria) were included. From each centre, 19 patients were randomly selected. Clinical histories (CH) were assessed by independent auditors, checking compliance with predefined quality criteria. The study was approved by ethics committees. ResultsWe included 856 patients (mean age 54 years; 71% women). The use of a combined index (CI) was recorded in 61% of cases. Visits were recorded every 4 weeks using a CI in 4% of CH while attempts were made to achieve remission. Monitoring of disease activity every 6–8 months after reaching the target was recorded in 73% of cases. ConclusionsThe implementation of the treat-to-target strategy is barely recorded in patients with RA in routine clinical practice." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl paradigma actual del manejo de la artritis reumatoide (AR) recomienda alcanzar un estado de remisión o baja actividad mediante la estrategia de «tratar por objetivos». Nuestro estudio evalúa la adhesión a esta estrategia. MétodoSe incluyeron pacientes con AR (criterios ACR-EULAR 2010). De cada centro, se eligieron al azar 19 pacientes. Auditores independientes evaluaron las historias clínicas (HC), verificando el cumplimiento de criterios de calidad predefinidos. El estudio fue aprobado por los comités de ética. ResultadosSe incluyeron 856 pacientes (edad media, 54 años; 71% mujeres). El uso de un índice combinado (IC) se recogió en el 61% de los casos. En el 4% de las HC se registraron visitas cada 4 semanas utilizando un IC mientras se intentaba alcanzar la remisión. La monitorización de actividad cada 6-8 meses tras alcanzar el objetivo se registró en el 73% de los casos. ConclusionesLa implementación de la estrategia de «tratar por objetivos» apenas está registrada en pacientes con AR en práctica clínica habitual." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: ACPA, anti-citrullinated peptides antibodies; DAS28esr, disease activity index based on erythrocyte sedimentation rate; RF, rheumatoid factor." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71% female \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (±SD) age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.3 (±15.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (±SD) disease duration (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 (±1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RF+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACPA+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DAS28esr at first consultation (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 (±1.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DAS28esr <3.2 or SDAI ≤11 in follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DAS28esr <2.6 or SDAI ≤3.3 in follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2559050.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the patients included in the study." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2014 update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological therapies in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Sanmartí" 1 => "S. García-Rodríguez" 2 => "J.M. Álvaro-Gracia" 3 => "J.L. Andreu" 4 => "A. Balsa" 5 => "R. Cáliz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2015.05.001" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "279" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26051464" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0095" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Singh" 1 => "K.G. Saag" 2 => "S.L. Bridges Jr." 3 => "E.A. Akl" 4 => "R.R. Bannuru" 5 => "M.C. Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.39977" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheumatol" "fecha" => "2016" "volumen" => "68" "paginaInicial" => "1" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27870508" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0100" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Smolen" 1 => "R. Landewé" 2 => "J. Bijlsma" 3 => "G. Burmester" 4 => "K. Chatzidionysiou" 5 => "M. Dougados" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2016-210715" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2017" "volumen" => "76" "paginaInicial" => "960" "paginaFinal" => "977" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28264816" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0105" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Grigor" 1 => "H. Capell" 2 => "A. Stirling" 3 => "A.D. McMahon" 4 => "P. Lock" 5 => "R. Vallance" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(04)16676-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2004" "volumen" => "364" "paginaInicial" => "263" "paginaFinal" => "269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15262104" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0110" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Verstappen" 1 => "J.W. Jacobs" 2 => "M.J. van der Veen" 3 => "A.H.M. Heurkens" 4 => "Y. Schenk" 5 => "E.J. ter Borg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.071092" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "1443" "paginaFinal" => "1449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519278" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0115" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of systematic monitoring of rheumatoid arthritis disease activity in daily practice: a multicentre, cluster randomised control trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Fransen" 1 => "H.B. Moens" 2 => "I. Speyer" 3 => "P.L. van Riel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2004.030924" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2005" "volumen" => "64" "paginaInicial" => "1294" "paginaFinal" => "1298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15829574" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0120" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The British Rheumatoid Outcome Study Group (BROSG) randomised controlled trial to compare the effectiveness and cost-effectiveness of aggressive versus symptomatic therapy in established rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Symmons" 1 => "K. Tricker" 2 => "C. Roberts" 3 => "L. Davies" 4 => "P. Dawes" 5 => "D.L. Scott" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Health Technol Assess" "fecha" => "2005" "volumen" => "9" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0125" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating rheumatoid arthritis to target: recommendations of an international task force" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Smolen" 1 => "D. Aletaha" 2 => "J.W. Bijlsma" 3 => "F.C. Breedveld" 4 => "D. Boumpas" 5 => "G. Burmester" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "631" "paginaFinal" => "637" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0130" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Smolen" 1 => "F.C. Breedveld" 2 => "G.R. Burmester" 3 => "V. Bykerk" 4 => "M. Dougados" 5 => "P. Emery" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2016" "volumen" => "75" "paginaInicial" => "3" "paginaFinal" => "15" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0135" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating Rheumatoid Arthritis to Target: multinational recommendations assessment questionnaire" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Haraoui" 1 => "J.S. Smolen" 2 => "D. Aletaha" 3 => "F.C. Breedveld" 4 => "G. Burmester" 5 => "C. Codreanu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2011.154179" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "1999" "paginaFinal" => "2002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21803747" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0140" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating rheumatoid arthritis to target: a Canadian physician survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Haraoui" 1 => "W. Bensen" 2 => "L. Bessette" 3 => "S. Le Clercq" 4 => "C. Thorne" 5 => "J. Wade" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Rheumatol" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "949" "paginaFinal" => "953" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0145" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating rheumatoid arthritis to target: an Italian rheumatologists’ survey on the acceptance of the treat-to-target recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Caporali" 1 => "F. Conti" 2 => "M. Covelli" 3 => "M. Govoni" 4 => "F. Salaffi" 5 => "G. Ventriglia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "471" "paginaFinal" => "476" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24960620" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0150" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Aletaha" 1 => "T. Neogi" 2 => "A.J. Silman" 3 => "J. Funovits" 4 => "D.T. Felson" 5 => "C.O. Bingham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2010.138461" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "1580" "paginaFinal" => "1588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20699241" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0155" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Vermeer" 1 => "H.H. Kuper" 2 => "H.J. Bernelot Moens" 3 => "M. Hoekstra" 4 => "M.D. Posthumus" 5 => "P.L. van Riel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/ar4099" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "R254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23176083" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0160" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Challenges in implementing treat-to-target strategies in rheumatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Ford" 1 => "D.H. Solomon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rdc.2018.09.007" "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2019" "volumen" => "45" "paginaInicial" => "101" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30447739" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0165" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.G. Schipper" 1 => "M. Vermeer" 2 => "H.H. Kuper" 3 => "M.O. Hoekstra" 4 => "C.J. Haagsma" 5 => "A.A. Den Broeder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2011-200274" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "845" "paginaFinal" => "850" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22210852" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0170" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Vermeer" 1 => "W. Kievit" 2 => "H.H. Kuper" 3 => "L.M. Braakman-Jansen" 4 => "H.J. Bernelot Moens" 5 => "T.R. Zijlstra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2474-14-350" "Revista" => array:5 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24330489" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack521621" "titulo" => "Acknowledgements" "texto" => "We thank to the Rheumatology units that accepted to be audited their help in the evaluation of clinical records and their commitment in the identification of areas of improvement in the management of RA patients." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001700000004/v1_202103261153/S2173574321000526/v1_202103261153/en/main.assets" "Apartado" => array:4 [ "identificador" => "43294" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001700000004/v1_202103261153/S2173574321000526/v1_202103261153/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000526?idApp=UINPBA00004M"]

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Brief Report

Treat-to-target strategy in patients with rheumatoid arthritis: Audit of adherence from real world clinical data

Estrategia de tratar por objetivos en pacientes con artritis reumatoide: auditoría de la adherencia en práctica clínica habitual

José-Luis Andréua,

Corresponding author

jlandreus@gmail.com

Corresponding author.

, María Auxiliadora Martínb, Héctor Corominasc, José Javier Pérez-Venegasd, José Andrés Román-Ivorrae, Fernando Sánchez-Alonsob, Ángel Gil de Miguelf

a Rheumatology Department, H.U. Puerta de Hierro Majadahonda, Majadahonda, Spain

b Research Unit, Sociedad Española de Reumatología, Madrid, Spain

c Unitat territorial de Reumatologia, Hospital Universitari de Sant Pau & Hospital Dos de Maig, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

d Rheumatology Department, H.C.U. Virgen Macarena, Sevilla, Spain

e Rheumatology Department, H.U.P. La Fe, Valencia, Spain

f Cátedra de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a systemic autoimmune disease whose main characteristic is a chronic inflammation of diarthrodial joints&#46; In absence of a successful therapy&#44; RA leads to irreversible destruction of articular structure&#44; functional impairment and loss of quality of life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">With the advent of biologic therapy and the optimal use of conventional disease-modifying anti-rheumatic drugs &#40;DMARDs&#41;&#44; being methotrexate &#40;MTX&#41; the corner-stone of RA treatment&#44; remission of disease or&#44; at least&#44; a state of low disease activity &#40;LDA&#41; are considered nowadays realistic goals in the management of RA&#44; as different guidelines and recommendations suggest&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several studies have compared standard of care by personal rheumatologist&#39;s judgement deciding the changes in therapy versus thigh control and dynamic escalation of the therapy according to pre-specified therapeutic targets&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">4&#8211;7</span></a> These studies have demonstrated better outcomes with the so called &#8220;treat to target&#8221; &#40;TTT&#41; strategies&#46; Thus&#44; the current paradigm of optimal clinical care of patients with RA recommends reaching a state of remission or LDA of the disease&#44; assessed by composite indexes of activity&#44; by means of a tight control and a dynamic adjustment of available therapeutic options&#44; using a TTT strategy&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the TTT strategy is widely known and assumed by rheumatologists as beneficial and feasible&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10&#8211;12</span></a> there are barriers in routine clinical practice that could hinder its wide implementation and the optimal management of RA patients&#46; The objective of our study was to objectively assess the level of implementation of the TTT recommendations in routine clinical care of RA patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study is an audit of clinical records of patients diagnosed of RA and managed in Spanish rheumatology units&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All the rheumatology units of Spain were invited to participate in the study&#46; Those units that accepted to participate sent to the research team a computerized anonymized list of adult patients fulfilling the 2010 ACR-EULAR criteria for RA<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> and diagnosed of RA between January 1st&#44; 2010 and December 31st&#44; 2013&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In order to accomplish an adequate representation of the RA population&#44; 19 patients were randomly chosen from the list provided by every department&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Independent auditors&#44; specifically trained by the research team&#44; assessed the clinical records&#44; verifying the fulfilling of the TTT recommendations in the management of the patients&#46; Clinical&#44; epidemiological and demographic data were recorded from every patient&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the ethic committees of every participant hospital&#46; Descriptive statistics was used for the presentation of the results&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Forty-six rheumatology units participated in the study&#46; From them&#44; a total of 856 clinical records&#44; randomly chosen&#44; were available for the audit&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the patients&#46; Mean age of them was 54 years and 71&#37; of patients were women&#46; Mean duration of RA was 2 years&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">An explicit assessment of the disease activity as a determinant element considered to select the therapy was recorded in 32&#37; of the CRs&#46; Use of at least a composite disease activity score &#40;DAS28&#44; SDAI or CDAI&#41; was recorded in 61&#37; of the cases&#46; In the follow-up&#44; 38&#37; of patients reached a state of low disease activity&#44; defined by a DAS28 &#60;3&#46;2 and&#47;or a SDAI &#8804;11&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In only 4&#37; of the CRs&#44; appointments every 4 weeks using a composite activity score had been recorded during the early stage while trying to reach remission after the diagnosis of RA&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Disease activity monitoring every 6&#8211;8 months after reaching the therapeutic target was recorded in 73&#37; of the cases&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In 99&#37; of the cases&#44; the clinicians had registered patient&#39;s comorbidities and these associated conditions had been considered in planning the therapeutic approach and objective&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Our data have shown a low implementation of the TTT strategy in the routine clinical practice of the rheumatology units participating in the study&#46; The data are somewhat disappointing since the widespread dissemination of TTT strategy and the acceptance of their feasibility by rheumatologists<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> would lead to the expectation of a wider implementation of this treatment strategy&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">There are several barriers that have been suggested for the implementation of the TTT strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Likely&#44; the main ones are the lack of time in real world clinical practice to use the compound indices of activity and the difficulty to get appointments for the patients with RA month by month during the escalation of medication to achieve a state of remission or&#44; at least&#44; LDA&#46; A potential solution would be to maintain preferential citation slots in order to monitor patients every 1&#8211;3 months&#46; This would require an additional effort in rheumatologist resources but&#44; on the other hand&#44; the TTT strategy has been shown to be more effective than usual care<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> and even cost-efficient in the medium and long term&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Although our results are quite disappointing&#44; we used a very stringent criterion&#44; four weeks&#44; to judge whether the TTT strategy was being followed&#46; Likely&#44; the results would not have been so poor if we had used 3 months instead of 4 weeks as the criterion of excellence to adjust the treatment of patients with RA during the escalation of therapy in order to reach a state of remission or LDA&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; a minority of the patients with RA are managed according to the TTT strategy&#44; that is&#44; using combined indices of activity to monitor the response to treatment and follow-up every 4 weeks until the therapeutic goal is achieved&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical approval</span><p id="par0095" class="elsevierStylePara elsevierViewall">This article does not contain any studies with human participants or animals performed by any of the authors&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Compliance with ethical standards</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study was funded by an unrestricted grant provided by the biopharmaceutical company <span class="elsevierStyleGrantSponsor" id="gs1">AbbVie</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46; &#193;ngel Gil de Miguel declares that he is Director of the Chair of Evaluation of Health Outcomes Universidad Rey Juan Carlos&#47;Abbvie&#46;</p></span></span>"
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    "fechaRecibido" => "2019-10-15"
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            0 => "Rheumatoid arthritis"
            1 => "Treat-to-target"
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          "clase" => "keyword"
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          "palabras" => array:2 [
            0 => "Artritis reumatoide"
            1 => "Terapia por objetivos"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The current paradigm of the management of rheumatoid arthritis &#40;RA&#41; recommends achieving a state of remission or low disease activity through the treat-to-target strategy&#46; Our study assesses adherence to this strategy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with RA &#40;ACR-EULAR 2010 criteria&#41; were included&#46; From each centre&#44; 19 patients were randomly selected&#46; Clinical histories &#40;CH&#41; were assessed by independent auditors&#44; checking compliance with predefined quality criteria&#46; The study was approved by ethics committees&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We included 856 patients &#40;mean age 54 years&#59; 71&#37; women&#41;&#46; The use of a combined index &#40;CI&#41; was recorded in 61&#37; of cases&#46; Visits were recorded every 4 weeks using a CI in 4&#37; of CH while attempts were made to achieve remission&#46; Monitoring of disease activity every 6&#8211;8 months after reaching the target was recorded in 73&#37; of cases&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The implementation of the treat-to-target strategy is barely recorded in patients with RA in routine clinical practice&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El paradigma actual del manejo de la artritis reumatoide &#40;AR&#41; recomienda alcanzar un estado de remisi&#243;n o baja actividad mediante la estrategia de &#171;tratar por objetivos&#187;&#46; Nuestro estudio eval&#250;a la adhesi&#243;n a esta estrategia&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron pacientes con AR &#40;criterios ACR-EULAR 2010&#41;&#46; De cada centro&#44; se eligieron al azar 19 pacientes&#46; Auditores independientes evaluaron las historias cl&#237;nicas &#40;HC&#41;&#44; verificando el cumplimiento de criterios de calidad predefinidos&#46; El estudio fue aprobado por los comit&#233;s de &#233;tica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 856 pacientes &#40;edad media&#44; 54 a&#241;os&#59; 71&#37; mujeres&#41;&#46; El uso de un &#237;ndice combinado &#40;IC&#41; se recogi&#243; en el 61&#37; de los casos&#46; En el 4&#37; de las HC se registraron visitas cada 4 semanas utilizando un IC mientras se intentaba alcanzar la remisi&#243;n&#46; La monitorizaci&#243;n de actividad cada 6-8 meses tras alcanzar el objetivo se registr&#243; en el 73&#37; de los casos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La implementaci&#243;n de la estrategia de &#171;tratar por objetivos&#187; apenas est&#225; registrada en pacientes con AR en pr&#225;ctica cl&#237;nica habitual&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ACPA&#44; anti-citrullinated peptides antibodies&#59; DAS28esr&#44; disease activity index based on erythrocyte sedimentation rate&#59; RF&#44; rheumatoid factor&#46;</p>"
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                  \t\t\t\t">Gender&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">71&#37; female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#46;3 &#40;&#177;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mean &#40;&#177;SD&#41; disease duration &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">ACPA&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">90&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">DAS28esr at first consultation &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">DAS28esr &#60;3&#46;2 or SDAI &#8804;11 in follow-up&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">DAS28esr &#60;2&#46;6 or SDAI &#8804;3&#46;3 in follow-up&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "2014 update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological therapies in rheumatoid arthritis"
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "R&#46; Sanmart&#237;"
                            1 => "S&#46; Garc&#237;a-Rodr&#237;guez"
                            2 => "J&#46;M&#46; &#193;lvaro-Gracia"
                            3 => "J&#46;L&#46; Andreu"
                            4 => "A&#46; Balsa"
                            5 => "R&#46; C&#225;liz"
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                      "doi" => "10.1016/j.reuma.2015.05.001"
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                        "volumen" => "11"
                        "paginaInicial" => "279"
                        "paginaFinal" => "294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26051464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Singh"
                            1 => "K&#46;G&#46; Saag"
                            2 => "S&#46;L&#46; Bridges Jr&#46;"
                            3 => "E&#46;A&#46; Akl"
                            4 => "R&#46;R&#46; Bannuru"
                            5 => "M&#46;C&#46; Sullivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.39977"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "68"
                        "paginaInicial" => "1"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27870508"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs&#58; 2016 update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Smolen"
                            1 => "R&#46; Landew&#233;"
                            2 => "J&#46; Bijlsma"
                            3 => "G&#46; Burmester"
                            4 => "K&#46; Chatzidionysiou"
                            5 => "M&#46; Dougados"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2016-210715"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2017"
                        "volumen" => "76"
                        "paginaInicial" => "960"
                        "paginaFinal" => "977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28264816"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0105"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of a treatment strategy of tight control for rheumatoid arthritis &#40;the TICORA study&#41;&#58; a single-blind randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Grigor"
                            1 => "H&#46; Capell"
                            2 => "A&#46; Stirling"
                            3 => "A&#46;D&#46; McMahon"
                            4 => "P&#46; Lock"
                            5 => "R&#46; Vallance"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)16676-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "263"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15262104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive treatment with methotrexate in early rheumatoid arthritis&#58; aiming for remission&#46; Computer Assisted Management in Early Rheumatoid Arthritis &#40;CAMERA&#44; an open-label strategy trial&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Verstappen"
                            1 => "J&#46;W&#46; Jacobs"
                            2 => "M&#46;J&#46; van der Veen"
                            3 => "A&#46;H&#46;M&#46; Heurkens"
                            4 => "Y&#46; Schenk"
                            5 => "E&#46;J&#46; ter Borg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2007.071092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2007"
                        "volumen" => "66"
                        "paginaInicial" => "1443"
                        "paginaFinal" => "1449"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of systematic monitoring of rheumatoid arthritis disease activity in daily practice&#58; a multicentre&#44; cluster randomised control trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Fransen"
                            1 => "H&#46;B&#46; Moens"
                            2 => "I&#46; Speyer"
                            3 => "P&#46;L&#46; van Riel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2004.030924"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2005"
                        "volumen" => "64"
                        "paginaInicial" => "1294"
                        "paginaFinal" => "1298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15829574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The British Rheumatoid Outcome Study Group &#40;BROSG&#41; randomised controlled trial to compare the effectiveness and cost-effectiveness of aggressive versus symptomatic therapy in established rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Symmons"
                            1 => "K&#46; Tricker"
                            2 => "C&#46; Roberts"
                            3 => "L&#46; Davies"
                            4 => "P&#46; Dawes"
                            5 => "D&#46;L&#46; Scott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Health Technol Assess"
                        "fecha" => "2005"
                        "volumen" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating rheumatoid arthritis to target&#58; recommendations of an international task force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Smolen"
                            1 => "D&#46; Aletaha"
                            2 => "J&#46;W&#46; Bijlsma"
                            3 => "F&#46;C&#46; Breedveld"
                            4 => "D&#46; Boumpas"
                            5 => "G&#46; Burmester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2010"
                        "volumen" => "69"
                        "paginaInicial" => "631"
                        "paginaFinal" => "637"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating rheumatoid arthritis to target&#58; 2014 update of the recommendations of an international task force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Smolen"
                            1 => "F&#46;C&#46; Breedveld"
                            2 => "G&#46;R&#46; Burmester"
                            3 => "V&#46; Bykerk"
                            4 => "M&#46; Dougados"
                            5 => "P&#46; Emery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2016"
                        "volumen" => "75"
                        "paginaInicial" => "3"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating Rheumatoid Arthritis to Target&#58; multinational recommendations assessment questionnaire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Haraoui"
                            1 => "J&#46;S&#46; Smolen"
                            2 => "D&#46; Aletaha"
                            3 => "F&#46;C&#46; Breedveld"
                            4 => "G&#46; Burmester"
                            5 => "C&#46; Codreanu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2011.154179"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "1999"
                        "paginaFinal" => "2002"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21803747"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating rheumatoid arthritis to target&#58; a Canadian physician survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Haraoui"
                            1 => "W&#46; Bensen"
                            2 => "L&#46; Bessette"
                            3 => "S&#46; Le Clercq"
                            4 => "C&#46; Thorne"
                            5 => "J&#46; Wade"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "39"
                        "paginaInicial" => "949"
                        "paginaFinal" => "953"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating rheumatoid arthritis to target&#58; an Italian rheumatologists&#8217; survey on the acceptance of the treat-to-target recommendations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Caporali"
                            1 => "F&#46; Conti"
                            2 => "M&#46; Covelli"
                            3 => "M&#46; Govoni"
                            4 => "F&#46; Salaffi"
                            5 => "G&#46; Ventriglia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Rheumatol"
                        "fecha" => "2014"
                        "volumen" => "32"
                        "paginaInicial" => "471"
                        "paginaFinal" => "476"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24960620"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2010 rheumatoid arthritis classification criteria&#58; an American College of Rheumatology&#47;European League Against Rheumatism collaborative initiative"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Aletaha"
                            1 => "T&#46; Neogi"
                            2 => "A&#46;J&#46; Silman"
                            3 => "J&#46; Funovits"
                            4 => "D&#46;T&#46; Felson"
                            5 => "C&#46;O&#46; Bingham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.138461"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2010"
                        "volumen" => "69"
                        "paginaInicial" => "1580"
                        "paginaFinal" => "1588"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20699241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to a treat-to-target strategy in early rheumatoid arthritis&#58; results of the DREAM remission induction cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Vermeer"
                            1 => "H&#46;H&#46; Kuper"
                            2 => "H&#46;J&#46; Bernelot Moens"
                            3 => "M&#46; Hoekstra"
                            4 => "M&#46;D&#46; Posthumus"
                            5 => "P&#46;L&#46; van Riel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/ar4099"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Res Ther"
                        "fecha" => "2012"
                        "volumen" => "14"
                        "paginaInicial" => "R254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23176083"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Challenges in implementing treat-to-target strategies in rheumatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;A&#46; Ford"
                            1 => "D&#46;H&#46; Solomon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rdc.2018.09.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheum Dis Clin North Am"
                        "fecha" => "2019"
                        "volumen" => "45"
                        "paginaInicial" => "101"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30447739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice&#58; a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;G&#46; Schipper"
                            1 => "M&#46; Vermeer"
                            2 => "H&#46;H&#46; Kuper"
                            3 => "M&#46;O&#46; Hoekstra"
                            4 => "C&#46;J&#46; Haagsma"
                            5 => "A&#46;A&#46; Den Broeder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-200274"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2012"
                        "volumen" => "71"
                        "paginaInicial" => "845"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22210852"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0170"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating to the target of remission in early rheumatoid arthritis is cost-effective&#58; results of the DREAM registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Vermeer"
                            1 => "W&#46; Kievit"
                            2 => "H&#46;H&#46; Kuper"
                            3 => "L&#46;M&#46; Braakman-Jansen"
                            4 => "H&#46;J&#46; Bernelot Moens"
                            5 => "T&#46;R&#46; Zijlstra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2474-14-350"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24330489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2019.10.003

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2023 June	22	33	55
2023 May	34	28	62
2023 April	15	7	22
2023 March	53	31	84
2023 February	42	25	67
2023 January	36	17	53
2022 December	58	32	90
2022 November	55	36	91
2022 October	66	42	108
2022 September	51	16	67
2022 August	33	30	63
2022 July	45	42	87
2022 June	34	33	67
2022 May	47	34	81
2022 April	44	46	90
2022 March	48	47	95
2022 February	43	35	78
2022 January	40	36	76
2021 December	18	48	66
2021 November	22	35	57
2021 October	32	59	91
2021 September	3	0	3

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